SLU COLLEGE OF NURSING Level 2 Basic Nutrition and Diet Therapy Laboratory Meal Planning I.

Brief background of the case Our client was diagnosed to have Diabetes mellitus type two. She stands 54, weighs 55kg and works as a sidewalk vendor. Make 1 day menu for the client using a diet with the following distribution: CHO- 65%, CHON- 15%, FAT- 20% These are recommended diet for patients who are suffering from Diabetes Mellitus type 2:
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Healthy carbohydrates. During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. Focus on the healthiest carbohydrates, such as fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products. Fiber-rich foods. Dietary fiber includes all parts of plant foods that your body can't digest or absorb. Fiber can decrease the risk of heart disease and help control blood sugar levels. Foods high in fiber include vegetables, fruits, nuts, legumes (beans, peas and lentils), whole-wheat flour and wheat bran. Heart-healthy fish. Eat heart-healthy fish at least twice a week. Fish can be a good alternative to high-fat meats. Cod, tuna and halibut, for example, have less total fat, saturated fat and cholesterol than do meat and poultry. Fish such as salmon, mackerel and herring are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides. However, avoid fried fish and fish with high levels of mercury, such as tilefish, swordfish and king mackerel. 'Good' fats. Foods containing monounsaturated and polyunsaturated fats such as avocados, almonds, pecans, walnuts, olives, and canola, olive and peanut oils can help lower your cholesterol levels. Eat them sparingly, however, as all fats are high in calories.

Foods to avoid Diabetes increases your risk of heart disease and stroke by accelerating the development of clogged and hardened arteries. Foods containing the following can work against your goal of a heart-healthy diet.
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Saturated fats. High-fat dairy products and animal proteins such as beef, hot dogs, sausage and bacon contain saturated fats. Get no more than 20 percent of your daily calories from saturated fat. Trans fats. These types of fats are found in processed snacks, baked goods, shortening and stick margarines and should be avoided completely. Cholesterol. Sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, shellfish, liver and other organ meats. Aim for no more than 200 milligrams (mg) of cholesterol a day. Sodium. Aim for less than 2,000 mg of sodium a day.

Putting it all together: Creating a plan

There are a few different approaches to creating a diabetes diet that keeps your blood glucose level within a normal range. With a dietitian's help, you may find one or a combination of methods that works for you.
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Counting carbohydrates. Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level. It's important to make sure your timing and amount of carbohydrates are the same each day, especially if you take diabetes medications or insulin. Otherwise, your blood glucose level may fluctuate more. A dietitian can teach you how to measure food portions and become an educated reader of food labels, paying special attention to serving size and carbohydrate content. If you're taking insulin, he or she can teach you how to count the amount of carbohydrates in each meal or snack and adjust your insulin dose accordingly.

The exchange system. A dietitian may recommend using the exchange system, which groups foods into categories such as carbohydrates, meats and meat substitutes, and fats. One serving in a group is called an "exchange." An exchange has about the same amount of carbohydrates, protein, fat and calories and the same effect on your blood glucose as a serving of every other food in that same group. So, for example, you could exchange or trade one small apple for 1/3 cup of cooked pasta, for one carbohydrate serving.

Glycemic index. Some people who have diabetes use the glycemic index to select foods, especially carbohydrates. Foods with a high glycemic index are associated with greater increases in blood sugar than are foods with a low glycemic index. But low-index foods aren't necessarily healthier, as foods that are high in fat tend to have lower glycemic index values than do some healthier options.

II. Dietary Computation A. Determining Ideal body weight using Tannhauser method DBW= 


 

 B. Total Energy Requirement TER   

C. Percent Distribution CHO = CHON = FATS =           kcal kcal kcal

D. Dietary Prescription CHO = CHON = FATS =         

E. Food Exchange Table TER = 2,250 kcal, 365g-85g-50g Food Exchanges CHO 3 3 40 12 24 25 107 cal of CHO 12 12 160 48 96 100 CHON 1 1 0 8 8 0 cal of CHON 4 4 0 32 32 0 FATS 0 0 0 0 5 0 cal of FATS 0 0 0 0 45 0 ENERGY 16 16 160 80 173 100

Veg List 2 A Veg List 1 B Fruits 4 Skim 1 Milk Low fat 2 milk Sugar 5 Partial Sum of CHO

365 - 107 = 258/23 = 11 no. of rice exchanges Rice list 11 253 1012 22 Partial Sum of 40 CHON 85 - 40 = 45/8 = 6 no. of meat exchanges Meat List A 6 0 0 48

88

1100

192

6 11

54

246

Partial sum of FATS 50 - 11 = 39/5 = no. of fat exchanges

Fat TOTAL:

8 CHO

0 360

0 CHON

0 88

0 FATS

40 50

360 CALORIES

360 2251

F. Sample Menu for a Day and Rationale FOOD **Breakfast** >1 exchange of low fat milk EXACT AMOUNT >1 tetra brick RATIONALE >Low-fat milk makes a healthy diabetes food choice because it has a lower glycemic index than 2 percent milk or whole milk. Milk sugar [lactose] is converted to blood sugar at a relatively slow rate, which is good for blood sugar control and reducing insulin levels. It also contains Mg that is needed for the making and secretion of insulin and also by the cells so they create more insulin receptors and therefore keep up their insulin sensitivity. The lack of Mg leads to insulin resistance and therefore high blood glucose. It also contains Ca and K >Foods high in potassium are the best treatment for diabetes. It is because the intake of potassium increases the functioning of pancreas >Oats is a good source of magnesium. Oatmeal has long ranked among the best foods for fighting cholesterol. This is because oatmeal and oat bran is rich in dietary fiber. This fiber contains a mixture of about half soluble and half insoluble fibers One component of the soluble fiber found in oats is beta-

>1exchange of fruit

>1 lakatan (9x3 cm)

>3 exchanges of rice

>1 cup of oatmeal (breakfast cereal)

glucan, soluble fiber. After soluble fiber dissolves in water, however, it traps nutrients inside its gummy gel and slows down considerably while moving through the digestive tract. Inside the gel, nutrients are shielded from digestive enzymes and less likely to reach the wall of the intestines. Dietary sugars like carbohydrates and starch are among the nutrients trapped inside this gel. Consequently, sugar is absorbed into the bloodstream more slowly, blunting the sharp spike in blood glucose typically experienced by diabetic patients after a meal. >1 exchange of sugar >1 tsp of honey >The use of honey produces a smaller blood glucose and insulin response than similar amounts of carbohydrate from sucrose. Since honey contains large amounts of fructose it tends to be sweeter (depending upon the temperature) than regular sugar, so that less may be used. >A good source of protein and protein reduces the glycemic index of a meal and also helps increase the muscle mass. Increasing intake of protein is also a way to weight loss as it is thermogenic by nature. >It helps to control blood sugar, levels. Due to their law glycaemic index, they promote a gradual increase in the blood sugar level which is highly beneficial to diabetics

** Snack** >1 exchange of skim milk

>1/2 cup of yoghurt

>1exchange of fruit

>1/4 cup of strawberry

**Lunch**

>2 exchanges of Veg. list A

>1 cup of cooked Ampalaya

>The blood sugar lowering property of ampalaya is attributed to its content momordicin, a substance that is sometimes called plant insulin. This is also the substance that is responsible for the bitter taste of of the plats leaves and fruits >Vitamin C packs a punch, they said, because it helps to clean up ("scavenge," in the words of lead researcher Antonio Ceriello) free radicals molecules that cause tissue damage. This is of particular concern for diabetics because diabetics' bodies produce more free radicals than those of nondiabetics. This is why diabetics are especially likely to suffer from heart disease. It is also why diabetics are prone to tissue and nerve damage in the feet and legs - damage that all-too-often necessitates amputation. >Brown rice is an ideal cereal option for people with diabetes owing to its extremely low glycemic index of 16. To add on to the heart healthy benefits is the abundance of minerals in this food.* Brown rice provides 46% DV of magnesium, 25% DV of zinc and 43% DV of selenium. Magnesium aids in effective functioning of insulin and zinc and selenium work as potential antioxidants. > Low fat sources of protein. Limiting fat can help prevent weight gain and reduce the risk of increasing blood cholesterol

>1exchange of fruit

>1/3 cup unsweetened pineapple

>3 exchanges of rice

>1 cup cooked brown rice

>3 exchanges of Meat list A

>3 slices of beef lean meat, matchbox size

>4 exchanges of fat

>4 tsps of butter or oil

>For palatability purposes and addition of extra flavor >A good source of milk also that contains magnesium, and a good source of CHO. >It contains mixture of fiber one of which is soluble fiber. After soluble fiber dissolves in water, however, it traps nutrients inside its gummy gel and slows down considerably while moving through the digestive tract. Inside the gel, nutrients are shielded from digestive enzymes and less likely to reach the wall of the intestines. Dietary sugars like carbohydrates and starch are among the nutrients trapped inside this gel. Consequently, sugar is absorbed into the bloodstream more slowly, blunting the sharp spike in blood glucose typically experienced by diabetic patients after a meal >Compared to normal white sugar, muscovado sugar retains all the cane sugar nutrients. High in minerals: potassium, calcium, iron, it has more health benefits compared to normal white sugar, which has zero nutrients, as the refining process to produce white sugar has practically eliminated all traces of nutrients from it. >Vitamin C packs a punch, they said, because it helps to clean up ("scavenge," in the words of lead researcher Antonio Ceriello) free radicals molecules that cause tissue damage. This is of particular

>1 exchange of sugar

>1 yema

**Snack** >2 exchanges of rice

>1 cup of binatog

>1 exchange of sugar

>1 teaspoon of brown sugar(muscuvado)

>1exchange of fruit

>1/3 cup of unsweetened orange

concern for diabetics because diabetics' bodies produce more free radicals than those of nondiabetics. This is why diabetics are especially likely to suffer from heart disease. It is also why diabetics are prone to tissue and nerve damage in the feet and legs - damage that all-too-often necessitates amputation ** Dinner** >1 exchange of Veg. list B >1/2 cup cooked toge or mungbean sprout >It contains mixture of fiber one of which is soluble fiber. After soluble fiber dissolves in water, however, it traps nutrients inside its gummy gel and slows down considerably while moving through the digestive tract. Inside the gel, nutrients are shielded from digestive enzymes and less likely to reach the wall of the intestines. Dietary sugars like carbohydrates and starch are among the nutrients trapped inside this gel. Consequently, sugar is absorbed into the bloodstream more slowly, blunting the sharp spike in blood glucose typically experienced by diabetic patients after a meal >Low-fat milk makes a healthy diabetes food choice because it has a lower glycemic index than 2 percent milk or whole milk. Milk sugar [lactose] is converted to blood sugar at a relatively slow rate, which is good for blood sugar control and reducing insulin levels. It also contains Mg that is needed for the making and secretion of insulin and also by the cells so they create more insulin receptors and therefore keep up their insulin sensitivity. The lack

>1 exchange of low fat milk

>1 tetra brick

of Mg leads to insulin resistance and therefore high blood glucose. It also contains Ca and K >3 exchanges of rice >1 cup of cooked brown rice >Brown rice is an ideal cereal option for people with diabetes owing to its extremely low glycemic index of 16. To add on to the heart healthy benefits is the abundance of minerals in this food.* Brown rice provides 46% DV of magnesium, 25% DV of zinc and 43% DV of selenium. Magnesium aids in effective functioning of insulin and zinc and selenium work as potential antioxidants. > Low fat sources of protein. Limiting fat can help prevent weight gain and reduce the risk of increasing blood cholesterol >For palatability purposes and addition of extra flavor >A good source of CHO

>3 exchanges of Meat list A

>1/4 chicken breast

>4 exchanges of fat

>4tsps of butter or oil

>2 exchange of sugar

>1 piece pulvoron (4x2 x 1 cm)

REFERENCES: y http://www.mayoclinic.com/health/diabetes-diet/DA00027/NSECTIONGROUP=2 y http://www.livestrong.com/article/449417-low-fat-milk-diabetes/#ixzz1f225GKih y http://www.prevention.com/health/nutrition/food-remedies/low-fat-diary-milk-anddiabetes/article/009c323b0b803110VgnVCM20000012281eac y http://www.diabetesexplained.com/magnesium-and-diabetes.html y http://www.diabetesmellitus-information.com/potassium_food.htm y http://len7288.hubpages.com/hub/Health-Benefits-of-Eating-Oats y http://www.konjacfoods.com/fiber.htm y http://www.vegetarian-nutrition.info/updates/honey.php y http://www.diabetesmellitus-information.com/diabetes_fruits.htm y http://library.pchrd.dost.gov.ph/index.php/news-archive/205

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http://blog.caloricious.com/2011/09/15/brown-rice-with-rasins-apple-and-skim-milkhealthy-diabetic-breakfast-option/ http://www.diseaseproof.com/archives/diabetes-diabetes-vitamin-c-good.html

Prepared by: MIRANDA, BRYLLE F. CARITATIVO, KATRINA MOLINA, LOVELY TUMANENG, WINZEL SANTOS, ANNA DOMINIQUE